Clinical Orthopaedics and Related Research®

, Volume 468, Issue 8, pp 2046–2051 | Cite as

Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure

  • S. Mehdi Jafari
  • Catelyn Coyle
  • S. M. Javad Mortazavi
  • Peter F. Sharkey
  • Javad Parvizi
Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society

Abstract

Background

Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established.

Questions/purposes

We therefore determined the rate of each failure mode and the survivorship of revision THAs.

Methods

We retrospectively reviewed the charts of 1366 revision THAs performed between 2000 and 2007. There were 609 (44.5%) men and 757 (55.5%) women with a mean age of 66 years. The indications for the revision surgery were mainly aseptic loosening (51%), instability (15%), wear (14%), and infection (8%). The minimum followup was 1 day (mean, 5.5 years; range, 1 day to 9 years).

Results

Two hundred fifty-six of the revisions (18.7%) failed with an average time to failure of 16.6 months (range, 1 day to 7.5 years). Among 256 failed hips, infection was the most common cause of failure (30.2%) followed by instability (25.1%) and aseptic loosening (19.4%). At 5 years, the survivorships of septic and aseptic groups were 67% and 84.8%, respectively. Revision for infection or instability appears to have a considerably lower survivorship when compared to revision for aseptic causes.

Conclusions

The lower survivorship of revision for infection or instability highlights the importance of implementing better preventative methods that can minimize the impact of these two major causes of failure.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am. 2002;84:1788–1792.PubMedGoogle Scholar
  2. 2.
    Barrack RL. Economics of revision total hip arthroplasty. Clin Orthop Relat Res. 1995;319:209–214.PubMedGoogle Scholar
  3. 3.
    Barrack RL, Hoffman GJ, Tejeiro WV, Carpenter LJ, Jr. Surgeon work input and risk in primary versus revision total joint arthroplasty. J Arthroplasty. 1995;10:281–286.CrossRefPubMedGoogle Scholar
  4. 4.
    Barrack RL, Sawhney J, Hsu J, Cofield RH. Cost analysis of revision total hip arthroplasty. A 5-year followup study. Clin Orthop Relat Res. 1999;369:175–178.CrossRefPubMedGoogle Scholar
  5. 5.
    Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–1254.CrossRefPubMedGoogle Scholar
  6. 6.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.CrossRefPubMedGoogle Scholar
  7. 7.
    Crowe JF, Sculco TP, Kahn B. Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res. 2003;413:175–182.CrossRefPubMedGoogle Scholar
  8. 8.
    Della Valle CJ, Shuaipaj T, Berger RA, Rosenberg AG, Shott S, Jacobs JJ, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report. J Bone Joint Surg Am. 2005;87:1795–1800.CrossRefPubMedGoogle Scholar
  9. 9.
    Dorey F, Amstutz HC. Survivorship analysis in the evaluation of joint replacement. J Arthroplasty. 1986;1:63–69.CrossRefPubMedGoogle Scholar
  10. 10.
    Hummel MT, Malkani AL, Yakkanti MR, Baker DL. Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty. 2009;24(6 Suppl):73–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete data. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  12. 12.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.CrossRefPubMedGoogle Scholar
  13. 13.
    Lavernia CJ, Drakeford MK, Tsao AK, Gittelsohn A, Krackow KA, Hungerford DS. Revision and primary hip and knee arthroplasty. A cost analysis. Clin Orthop Relat Res. 1995;311:136–141.PubMedGoogle Scholar
  14. 14.
    Levine DB, Cole BJ, Rodeo SA. Cost awareness and cost containment at the Hospital for Special Surgery. Strategies and total hip replacement cost centers. Clin Orthop Relat Res. 1995;311:117–124.PubMedGoogle Scholar
  15. 15.
    Lie SA, Havelin LI, Furnes ON, Engesaeter LB, Vollset SE. Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 2004;86:504–509.PubMedGoogle Scholar
  16. 16.
    McCarthy JC, Lee JA. Complex revision total hip arthroplasty with modular stems at a mean of 14 years. Clin Orthop Relat Res. 2007;465:166–169.PubMedGoogle Scholar
  17. 17.
    Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006;446:22–28.CrossRefPubMedGoogle Scholar
  18. 18.
    Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am. 2008;90:1134–1142.PubMedGoogle Scholar
  19. 19.
    Ritter MA, Carr KD, Keating EM, Faris PN, Bankoff DL, Ireland PM. Revision total joint arthroplasty: does medicare reimbursement justify time spent? Orthopedics. 1996;19:137–139.PubMedGoogle Scholar
  20. 20.
    Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res. 2009;467:166–173.CrossRefPubMedGoogle Scholar
  21. 21.
    Suh KT, Roh HL, Moon KP, Shin JK, Lee JS. Posterior approach with posterior soft tissue repair in revision total hip arthroplasty. J Arthroplasty. 2008;23:1197–1203.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • S. Mehdi Jafari
    • 1
  • Catelyn Coyle
    • 1
  • S. M. Javad Mortazavi
    • 2
  • Peter F. Sharkey
    • 1
  • Javad Parvizi
    • 1
  1. 1.Department of Orthopaedic SurgeryRothman Institute at Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of Orthopaedic SurgeryImam University Hospital, Tehran University of Medical SciencesTehranIran

Personalised recommendations